Going round in circles

We all, from time to time, see patients who present with a long list of obscure and diverse symptoms, which don’t seem to fit with any recognised diagnosis. Sometimes, the symptoms seem utterly improbable, such as itchy teeth or painful hair, often associated with more non-specific complaints, such as fatigue and ‘aches and pains’. They have almost invariably been seen by multiple different specialists, have had a wide range of investigations, and have sometimes acquired a diagnostic label such as chronic Lyme disease, candidiasis, total allergy syndrome, or fibromyalgia, and not infrequently more than one of these. The consultations tend to be long, circuitous, and unproductive, both for the doctor and their dissatisfied patient, and usually end either with further unnecessary tests being done or yet another second opinion being sought. Of course, if enough tests are done, inevitably one of them with come back with a borderline abnormality, which will set in train further unproductive consultations and tests. No amount of reassurance ever seems to assist, and one hesitates to think how much their care costs over the years.